Implement the Care Delivery and Payment Transformations
What does it mean to implement the care delivery and payment transformations, and why is it important?
Implementing care delivery and payment transformations marks the critical phase where your team puts plans into action. Even with a strong equity culture, a clear health equity focus, and well-designed interventions, you should anticipate unexpected implementation challenges.
To succeed, execute strategically, stay adaptable, and commit to continuous learning. Don’t treat health equity as a standalone effort—use the momentum of implementing your care and payment transformations to identify other ways to integrate equity into all of your quality improvement work.
When you implement equity-focused changes in a structured, measurable, and scalable way, you create sustainable impact and improve health outcomes for all.
When should I implement the care delivery and payment transformations?
Implementation should begin once:
- Care delivery and payment transformations have been designed.
- All key stakeholders have been identified, their buy-in earned, and they are aligned on goals and priorities for equitable care delivery and outcomes.
- You have addressed the content and recommendations in each of the Roadmap’s three Essential Elements or have a concrete plan to address them before or during implementation.
- Infrastructure is in place to track progress, measure impact, and refine strategies over time.
If organizations wait too long to implement, momentum can be lost. Taking action and iterating along the way ensures continuous progress.
How should I implement the care delivery and payment transformations?
Start small, learn quickly, and adapt continuously. Use tools like the Plan-Do-Study-Act (PDSA) cycle and pilot testing to spot challenges early and refine your approach before scaling. Track process measures to demonstrate early progress, and stay flexible when clearing implementation hurdles while remaining grounded in your core equity goals.
As your work evolves, focus on measuring equity gaps—not just overall improvement—to ensure that care truly improves for those most affected by disparities.
First, review the Designing and Implementing Integrated Care and Payment Transformation Initiatives to Advance Health Equity: Lessons Learned from Three Pioneering Health Care Provider and Health Plan Partnerships resource about three multi-organization partnerships implementing their equity-focused care and payment transformation models. Their experiences are used as examples in the presentation described next.
Second, review the Implementing the Integrated Care Delivery and Payment Transformations presentation as a team. Reserve time to discuss how the information can be applied to your initiative, work through questions, and begin designing your implementation strategy.
Third, use the Stakeholder Identification and Action Planning Tool. Complete each of the steps to verify that you identified all stakeholders and implemented your development plan for each.
Fourth, review the tools and resources in the Partner with Patients and Community-Based Organizations and the Anticipate Data Challenges and Opportunities components of the Roadmap. Identify remaining tasks that apply to your initiative and incorporate them into your implementation plan.
Fifth, consider an implementation plan that includes pilot testing your initiative (e.g., in a single organization or clinic) and conducting one or more PDSA cycles before full-scale implementation.
Sixth, consider conducting scenario planning for your initiative to mitigate the negative impacts of unanticipated implementation challenges and fully benefit from unanticipated opportunities.
Resources to Implement the Care Delivery and Payment Transformations:
Designing and Implementing Integrated Care and Payment Transformation Initiatives to Advance Health Equity: Lessons Learned from Three Pioneering Health Care Provider and Health Plan Partnerships
Sometimes it is helpful to learn from the experiences of others. This report presents case studies of care and payment transformation models designed and implemented by three pairs of health care provider and health plan partnerships to advance health equity. See page 37 for important lessons that they learned about anticipating data challenges.
Implementing the Integrated Care Delivery and Payment Transformations (Presentation)
The Implementing the Integrated Care Delivery and Payment Transformations presentation guides teams through putting their equity-focused care and payment redesign into action, covering four key implementation strategies — transformation fit, organizational prerequisites, stakeholder adoption, and internal communication — alongside essential elements such as community partnership, stakeholder buy-in, and data readiness.
It also introduces practical frameworks for pilot testing, measurement, and evaluation, using real-world case studies from Washington, Delaware, and Mississippi to illustrate how teams can start small, track progress, and scale their efforts over time.
Stakeholder Identification and Action Planning Tool
A three-exercise tool for identifying key stakeholders, mapping their relationships and influence, and developing tailored action plans to earn and sustain their buy-in throughout the initiative.
Institute for Healthcare Improvement’s Plan-Do-Study-Act (PDSA) Worksheet and educational materials
The Plan-Do-Study-Act (PDSA) Worksheet is a useful quality improvement tool for documenting a test of change. The PDSA cycle is shorthand for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act).
Use the Plan-Do-Study-Act (PDSA) Worksheet to help your team plan and document tests of your initiative.
Scenario Planning Facilitator Guide
Make sure to review the Scenario Planning Facilitator Guide in its entirety before leading your team through the exercise.
Assessing Implementation
| Rollout Approach | Discussion Prompts |
|---|---|
| Are the care and payment models being rolled out simultaneously or sequentially? | * If sequential, which comes first — and is there a risk that one model gets entrenched before the other is ready? * Are the teams responsible for each model coordinated closely enough to avoid misalignment? * Has the rollout sequence been communicated clearly to all partner organizations? |
| Is the initiative starting with a pilot, and is there a clear plan for what “success” looks like before scaling? | * How was the pilot site or population selected — does it reflect the broader initiative context? * What specific criteria or thresholds will trigger a decision to scale, adapt, or stop? * Who has the authority to make that call, and when? |
| Iterative improvement | Discussion Prompts |
|---|---|
| Is there a PDSA cycle or equivalent iterative learning process built into the implementation? | * How frequently is the team formally stepping back to assess what’s working and what isn’t? * Are frontline implementers part of the review and adaptation process, or just leadership? * Is there documented flexibility in the model design to make changes without requiring full re-approval? |
| Disruption preparedness | Discussion Prompts |
|---|---|
| Is the team prepared for unanticipated disruptions — leadership turnover, vendor changes, staffing shifts, or loss of institutional support? | * Are multiple senior leaders knowledgeable about and invested in the initiative — or is support concentrated in one or two people? * Are there active champions at multiple levels across all partner organizations, not just at the top? * Has the team used a scenario planning tool to anticipate likely disruptions and pre-define response strategies? |
About the Roadmap Goal and Objective Setting Tool
This tool helps your team realize your vision to reduce and eliminate health and healthcare inequities by providing a centralized resource to:
- Establish process goals that align with each Roadmap component;
- Document task status, champions, and detailed notes;
- Monitor progress across multiple Roadmap components simultaneously; and
- Promote consistent team communication, accountability, and progress.
Use this tool to facilitate and document the development, implementation, and evaluation phases of your health equity initiative.